Operate, actions
Actions
Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.
Eligibility engine
1,339
Eligibility conflict resolved
1,339 proposed
Claims processor
9,112
Orphan claim re-pointed
9,112 executed
Outreach
7,319
Outreach address corrected, Outreach suppressed pending steward
2,993 proposed4,326 held
Next-best-action
3,896
Care coordination outreach, New member onboarding
3,896 proposed
Member services
4,974
Duplicate member record retired
4,974 executed
Actions
26,640 derived from the last resolution run
| Action | Type | Title | Detail | Linked to | Status | Executed | |
|---|---|---|---|---|---|---|---|
| ACT-016345 | Outreach suppressed pending steward Outreach | PRV-25556 (Wei Schultz) held until CASE-002901 is decided |
| Held | — | ||
| ACT-016346 | Outreach suppressed pending steward Outreach | CLM-429325 (Albert Flores) held until CASE-002902 is decided |
| Held | — | ||
| ACT-016347 | Outreach suppressed pending steward Outreach | CLM-427315 (Barb Le) held until CASE-002903 is decided |
| Held | — | ||
| ACT-016348 | Outreach suppressed pending steward Outreach | CLM-410219 (David Yang) held until CASE-002904 is decided |
| Held | — | ||
| ACT-016349 | Outreach suppressed pending steward Outreach | TPA-60323 (Joseph Kim) held until CASE-002905 is decided |
| Held | — | ||
| ACT-016350 | Outreach suppressed pending steward Outreach | PRV-26915 (Joseph Kim) held until CASE-002906 is decided |
| Held | — | ||
| ACT-016351 | Outreach suppressed pending steward Outreach | CLM-425130 (Wei Medina) held until CASE-002907 is decided |
| Held | — | ||
| ACT-016352 | Outreach suppressed pending steward Outreach | CLM-407449 (Jordan Parker) held until CASE-002908 is decided |
| Held | — | ||
| ACT-016353 | Outreach suppressed pending steward Outreach | ENR-109766 (Jordan Parker) held until CASE-002909 is decided |
| Held | — | ||
| ACT-016354 | Outreach suppressed pending steward Outreach | PRV-27612 (Ruth Moreno) held until CASE-002910 is decided |
| Held | — | ||
| ACT-016355 | Outreach suppressed pending steward Outreach | TPA-60316 (Carl Cook) held until CASE-002911 is decided |
| Held | — | ||
| ACT-016356 | Outreach suppressed pending steward Outreach | CLM-417697 (Pamela Lawson) held until CASE-002912 is decided |
| Held | — | ||
| ACT-016357 | Outreach suppressed pending steward Outreach | CLM-417698 (Pamela Lawson) held until CASE-002913 is decided |
| Held | — | ||
| ACT-016358 | Outreach suppressed pending steward Outreach | CLM-410363 (Mason Chen) held until CASE-002914 is decided |
| Held | — | ||
| ACT-016359 | Outreach suppressed pending steward Outreach | CLM-431023 (Aaron Freeman) held until CASE-002915 is decided |
| Held | — | ||
| ACT-016360 | Outreach suppressed pending steward Outreach | PRV-29066 (Aaron Freeman) held until CASE-002916 is decided |
| Held | — | ||
| ACT-016361 | Outreach suppressed pending steward Outreach | ENR-140741 (Aaron Freeman) held until CASE-002917 is decided |
| Held | — | ||
| ACT-016362 | Outreach suppressed pending steward Outreach | ENR-119510 (Rachel Wells) held until CASE-002918 is decided |
| Held | — | ||
| ACT-016363 | Outreach suppressed pending steward Outreach | TPA-56536 (Rachel Wells) held until CASE-002919 is decided |
| Held | — | ||
| ACT-016364 | Outreach suppressed pending steward Outreach | ENR-129223 (Andrea Wells) held until CASE-002920 is decided |
| Held | — | ||
| ACT-016365 | Outreach suppressed pending steward Outreach | PRV-25296 (Roger Moreno) held until CASE-002921 is decided |
| Held | — | ||
| ACT-016366 | Outreach suppressed pending steward Outreach | ENR-123501 (Roger Moreno) held until CASE-002922 is decided |
| Held | — | ||
| ACT-016367 | Outreach suppressed pending steward Outreach | TPA-61475 (Joe Adams) held until CASE-002923 is decided |
| Held | — | ||
| ACT-016368 | Outreach suppressed pending steward Outreach | ENR-133981 (Joe Adams) held until CASE-002924 is decided |
| Held | — | ||
| ACT-016369 | Outreach suppressed pending steward Outreach | CLM-431191 (Austin Lucas) held until CASE-002925 is decided |
| Held | — | ||
| ACT-016370 | Outreach suppressed pending steward Outreach | TPA-60488 (Anna Wong) held until CASE-002926 is decided |
| Held | — | ||
| ACT-016371 | Outreach suppressed pending steward Outreach | CLM-400749 (Natalie Jacobs) held until CASE-002927 is decided |
| Held | — | ||
| ACT-016372 | Outreach suppressed pending steward Outreach | ENR-100999 (Natalie Jacobs) held until CASE-002928 is decided |
| Held | — | ||
| ACT-016373 | Outreach suppressed pending steward Outreach | TPA-55997 (Dnaiel Sanchez) held until CASE-002929 is decided |
| Held | — | ||
| ACT-016374 | Outreach suppressed pending steward Outreach | CLM-413036 (Michael George) held until CASE-002930 is decided |
| Held | — | ||
| ACT-016375 | Outreach suppressed pending steward Outreach | ENR-113171 (Mason Brooks) held until CASE-002931 is decided |
| Held | — | ||
| ACT-016376 | Outreach suppressed pending steward Outreach | TPA-54371 (Mason Brooks) held until CASE-002932 is decided |
| Held | — | ||
| ACT-016377 | Outreach suppressed pending steward Outreach | ENR-106619 (Camila Cook) held until CASE-002933 is decided |
| Held | — | ||
| ACT-016378 | Outreach suppressed pending steward Outreach | CLM-405021 (Camila Cook) held until CASE-002934 is decided |
| Held | — | ||
| ACT-016379 | Outreach suppressed pending steward Outreach | TPA-58949 (Jean Martin) held until CASE-002935 is decided |
| Held | — | ||
| ACT-016380 | Outreach suppressed pending steward Outreach | CLM-429111 (Christopher Stevens) held until CASE-002936 is decided |
| Held | — | ||
| ACT-016381 | Outreach suppressed pending steward Outreach | CLM-417673 (Andrea Patel) held until CASE-002937 is decided |
| Held | — | ||
| ACT-016382 | Outreach suppressed pending steward Outreach | TPA-64354 (Ahmed Adams) held until CASE-002938 is decided |
| Held | — | ||
| ACT-016383 | Outreach suppressed pending steward Outreach | CLM-428340 (Scott Medina) held until CASE-002939 is decided |
| Held | — | ||
| ACT-016384 | Outreach suppressed pending steward Outreach | TPA-62803 (Russell Lee) held until CASE-002940 is decided |
| Held | — | ||
| ACT-016385 | Outreach suppressed pending steward Outreach | TPA-61487 (Aaron Morales) held until CASE-002941 is decided |
| Held | — | ||
| ACT-016386 | Outreach suppressed pending steward Outreach | PRV-27656 (Aaron Morales) held until CASE-002942 is decided |
| Held | — | ||
| ACT-016387 | Outreach suppressed pending steward Outreach | CLM-411909 (Randy Webb) held until CASE-002943 is decided |
| Held | — | ||
| ACT-016388 | Outreach suppressed pending steward Outreach | CLM-418860 (Abigail Garza) held until CASE-002944 is decided |
| Held | — | ||
| ACT-016389 | Outreach suppressed pending steward Outreach | ENR-124828 (Abigail Garza) held until CASE-002945 is decided |
| Held | — | ||
| ACT-016390 | Outreach suppressed pending steward Outreach | TPA-53547 (Samuel Wheeler) held until CASE-002946 is decided |
| Held | — | ||
| ACT-016391 | Outreach suppressed pending steward Outreach | TPA-52553 (Astin Riley) held until CASE-002947 is decided |
| Held | — | ||
| ACT-016392 | Outreach suppressed pending steward Outreach | ENR-142561 (Hannah Dominguez) held until CASE-002948 is decided |
| Held | — | ||
| ACT-016393 | Outreach suppressed pending steward Outreach | TPA-53594 (Ana Richards) held until CASE-002949 is decided |
| Held | — | ||
| ACT-016394 | Outreach suppressed pending steward Outreach | PRV-22408 (Ana Richards) held until CASE-002950 is decided |
| Held | — |
Derivation rules
Evaluated after every gold rebuild
- 1Eligibility conflict resolvedThe records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
- 2Orphan claim re-pointedA claim arrived without a member ID. Resolution attached it to an identity that has one, so the claims processor can now pay it against the right member.
- 3Outreach address correctedThe most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
- 4Outreach suppressed pending stewardThe record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
- 5Care coordination outreachThree or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
- 6New member onboardingA single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
- 7Duplicate member record retiredTwo or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.